Project beneficiaries Questionnaire

OMB No. 0581-0240

Grant Program Project Beneficiaries Questionnaire

Purpose

AMS values diversity and equal access to its programs and services. As such, it is helpful for us to track the impact of our Federal grant programs on a variety of communities.

This information is voluntary. The information contained herein will only be used to assist AMS with its outreach efforts.

Organization Information

Organization Name: Enter the Legal Name of the Organization

Employer Identification Number: Enter Organization’s EIN

Authorized Organization Representative (AOR): Enter the Name of the AOR

Project Beneficiaries

Please indicate any specific communities on which your grant award will have a major impact:

Ethnic Groups	Mark All that Apply
American Indian or Alaska Native	☐
Black or African American	☐
Asian	☐
Hispanic or Latino	☐
Native Hawaiian or Other Pacific Islander	☐

Farmers and Ranchers	Mark All that Apply
Women Farmers or Ranchers	☐
Youth Farmers or Ranchers	☐
Beginning Farmers or Ranchers	☐
Socially Disadvantaged Farmers or Ranchers	☐
Rural Farmers or Ranchers	☐
Urban Farmers or Ranchers	☐
Appalachia Farmers or Ranchers	☐
Certified Organic Farmers or Ranchers	☐

Other Beneficiaries	Mark All that Apply
Low Income/Low Access Communities	☐
Children	☐
Youth	☐
Elderly	☐
Minority-Serving Institutions	☐
Rural Communities	☐
Urban Communities	☐

Definitions of Ethnic Categories

American Indian or Alaska Native (Not Hispanic or Latino)
A person having origins in any of the original peoples of North and South America (including Central America), and who maintain tribal affiliation or community attachment.

Black or African American (Not Hispanic or Latino)
A person having origins in any of the Black racial groups of Africa.

Asian (Not Hispanic or Latino)
A person having origins in any of the original peoples of the Far East, Southeast Asia, or the Indian Subcontinent, including, for example, Cambodia, China, India, Japan, Korea, Malaysia, Pakistan, the Philippine Islands, Thailand, and Vietnam.

Hispanic or Latino
A person of Cuban, Mexican, Puerto Rican, South or Central American, or other Spanish culture or origin regardless of race.

Native Hawaiian or Other Pacific Islander (Not Hispanic or Latino)
A person having origins in any of the peoples of Hawaii, Guam, Samoa, or other Pacific Islands.

Definitions of Farmers and Ranchers Categories

Youth Farmers or Ranchers
Youth farmers or ranchers between the ages of 15 and 24 years.

Beginning Farmers or Ranchers
An individual or entity that has not operated a farm or ranch for more than 10 years and substantially participates in the operation.

Socially Disadvantaged Farmers or Ranchers
A farmer or rancher who is a member of a socially disadvantaged group. A Socially Disadvantaged Group is a group whose members have been subject to discrimination on the basis of race, color, national origin, age, disability, and where applicable, sex, marital status, familial status, parental status, religion, sexual orientation, genetic information, political beliefs, reprisal, or because all or a part of an individual's income is derived from any public assistance program.

Rural Farmers or Ranchers
Farmers or ranchers benefitting from the project are located in nonmetropolitan (nonmetro) areas, defined on the basis of counties. Nonmetro counties include some combination of: open countryside, rural towns (places with fewer than 2,500 people), and urban areas with populations ranging from 2,500 to 49,999 that are not part of larger labor market areas (metropolitan areas). See ERS Rural Classification Page: http://www.ers.usda.gov/topics/rural-economy-population/rural-classifications.aspx.

Urban Farmers and Ranchers
Farmers or Ranchers benefitting from the project are located in Urbanized Areas of 50,000 or more people or Urban Clusters of at least 2,500 and less than 50,000 people.

Appalachia Farmers or Ranchers
Farmers or ranchers benefitting from the project are located in the Appalachian Region, defined in Appalachian Regional Commission’s authorizing legislation, as a 205,000-square-mile region that follows the spine of the Appalachian Mountains from southern New York to northern Mississippi. It includes all of West Virginia and parts of 12 other states: Alabama, Georgia, Kentucky, Maryland, Mississippi, New York, North Carolina, Ohio, Pennsylvania, South Carolina, Tennessee, and Virginia. See http://www.arc.gov/counties for specific counties within the Appalachian Region.

Certified Organic Farmers or Ranchers
Farmers or ranchers operations or farms benefitting from the project are certified by a USDA accredited certifying agent. See the USDA National Organic Program Organic Certification & Accreditation.

Definitions of Other Beneficiaries Categories

Low Income/Low Food Access Communities
Consumers or targeted communities benefiting from the project are located in a low income/low access census tract location as defined by one of the four major map layers on the ERS Food Access Research Atlas map

Children
Project specifically benefits persons between the ages of 1 – 14.

Youth
Persons between the ages of 15 and 24 years.

Elderly
Project specifically benefits individuals who are 60 years of age or older.

Minority-Serving Institutions (MSI)
Project benefits colleges and universities that provide educational opportunities to those who have historically faced inequality in their access to higher education. See definition at http://nifa.usda.gov/glossary#M.

Rural Communities
Communities benefitting from the project are located in nonmetro areas, defined on the basis of counties. Nonmetro counties include some combination of: open countryside, rural towns (places with fewer than 2,500 people), and urban areas with populations ranging from 2,500 to 49,999 that are not part of larger labor market areas (metropolitan areas). See ERS Rural Classification Page: http://www.ers.usda.gov/topics/rural-economy-population/rural-classifications.aspx.

Urban Communities
Communities benefitting from the project are located in Urbanized Areas of 50,000 or more people or Urban Clusters of at least 2,500 and less than 50,000 people. See ERS Rural Classification Page: http://www.ers.usda.gov/topics/rural-economy-population/rural-classifications.aspx.

According to the Paperwork Reduction Act of 1995, an agency may not conduct or sponsor, and a person is not required to respond to a collection of information unless it displays a valid OMB control number. The valid OMB control number for this information collection is 0581-0240. The time required to complete this information collection is estimated to average 30 minutes per response, including the time for reviewing instructions, searching existing data sources, gathering and maintaining the data needed, and completing and reviewing the collection of information.

USDA’s Nondiscrimination Statement (effective 2015)

In accordance with Federal civil rights law and U.S. Department of Agriculture (USDA) civil rights regulations and policies, the USDA, its Agencies, offices, and employees, and institutions participating in or administering USDA programs are prohibited from discriminating based on race, color, national origin, religion, sex, gender identity (including gender expression), sexual orientation, disability, age, marital status, family/parental status, income derived from a public assistance program, political beliefs, or reprisal or retaliation for prior civil rights activity, in any program or activity conducted or funded by USDA (not all bases apply to all programs). Remedies and complaint filing deadlines vary by program or incident.

Persons with disabilities who require alternative means of communication for program information (e.g., Braille, large print, audiotape, American Sign Language, etc.) should contact the responsible Agency or USDA’s TARGET Center at (202) 720-2600 (voice and TTY) or contact USDA through the Federal Relay Service at (800) 877-8339. Additionally, program information may be made available in languages other than English.

To file a program discrimination complaint, complete the USDA Program Discrimination Complaint Form, AD-3027, found online at http://www.ascr.usda.gov/complaint_filing_cust.html and at any USDA office or write a letter addressed to USDA and provide in the letter all of the information requested in the form. To request a copy of the complaint form, call (866) 632-9992. Submit your completed form or letter to USDA by:

1. mail: U.S. Department of Agriculture Office of the Assistant Secretary for Civil Rights 1400 Independence Avenue, SW Washington, D.C. 20250-9410;

2. fax: (202) 690-7442; or

3. email: [email protected].

USDA is an equal opportunity provider, employer, and lender.